Li Yu-Hua, Wan Yue-Meng, Wu Hua-Mei, Huang Song-Quan
Kunming medical university Second Hospital, CN.
J Belg Soc Radiol. 2022 Jun 29;106(1):62. doi: 10.5334/jbsr.2741. eCollection 2022.
Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established approach for the management of variceal bleeding, refractory ascites, hepatic hydrothorax, and preoperative treatment of portal hypertension prior to major abdominal surgery in patients with compensated cirrhosis, and so on. This study aimed to investigate the safety and long-term efficacy of TIPS implantation using Viatorr TIPS stent-grafts.
A cohort of 59 patients undergoing TIPS placement using Viatorr TIPS stent-grafts were included, and the periprocedural events, and long-term mortality, shunt dysfunction, variceal rebleeding and incidence of hepatic encephalopathy (HE) were analyzed.
The technical success rate was 100%. The median portosystemic pressure gradient was reduced from 21 mmHg (interquatile range: 19-25) to 13 mmHg (interquatile range: 10-16) before and after TIPS, leading to a hemodynamic success rate of 72.9%. The cumulative rate of overall mortality was 34.2% at five years, and direct bilirubin (hazard ratio [HR] = 1.336, 95% confidence interval [CI]: 1.050-1.700, P = 0.018) and post-TIPS right atrial pressure (HR = 1.238, 95% CI: 1.015-1.510, P = 0.035) were independent predictors for mortality. The cumulative rates of shunt dysfunction and variceal rebleeding were 11.0% and 28.3% at five years, respectively, and portal venous pressure gradient (HR = 2.572, 95% CI: 1.094-6.047, P = 0.030) was the only independent predictor for shunt dysfunction. The cumulative four-year HE-free rate was 48.6%. No severe adverse event was noted during TIPS procedures.
Elective TIPS implantation using Viatorr TIPS stent-grafts is generally safe, and the long-term efficacy is favorable for the treatment of cirrhotic patients with recurrent variceal bleeding or refractory ascites.
经颈静脉肝内门体分流术（TIPS）是治疗静脉曲张破裂出血、顽固性腹水、肝性胸水以及代偿期肝硬化患者腹部大手术前门静脉高压术前治疗等的成熟方法。本研究旨在探讨使用Viatorr TIPS覆膜支架进行TIPS植入术的安全性和长期疗效。
纳入59例使用Viatorr TIPS覆膜支架进行TIPS置入的患者，分析围手术期事件以及长期死亡率、分流功能障碍、静脉曲张再出血和肝性脑病（HE）的发生率。
技术成功率为100%。TIPS术前术后门静脉压力梯度中位数从21 mmHg（四分位间距：19 - 25）降至13 mmHg（四分位间距：10 - 16），血流动力学成功率为72.9%。五年时总死亡率累积率为34.2%，直接胆红素（风险比[HR]=1.336，95%置信区间[CI]：1.050 - 1.700，P = 0.018）和TIPS术后右心房压力（HR = 1.238，95% CI：1.015 - 1.510，P = 0.035）是死亡率的独立预测因素。五年时分流功能障碍和静脉曲张再出血的累积率分别为11.0%和28.3%，门静脉压力梯度（HR = 2.572，95% CI：1.094 - 6.047，P = 0.030）是分流功能障碍的唯一独立预测因素。四年无HE累积率为48.6%。TIPS手术期间未观察到严重不良事件。
使用Viatorr TIPS覆膜支架进行择期TIPS植入术总体安全，长期疗效有利于治疗复发性静脉曲张出血或顽固性腹水的肝硬化患者。
